Longitudinal Impacts of Body Mass Index on Dysmenorrhea Among Adolescent Girls in Uganda

Background

Adolescent girls and adult women commonly experience menstrual pain, medically termed dysmenorrhea. Variation in Body Mass Index (BMI) is of particular interest as it has been associated with menstrual irregularities and the experience of dysmenorrhea. Socioeconomic status also plays a role in dysmenorrhea, potentially by constraining access to nutritious food, which may ultimately have long-term impacts on menstrual health. Applying the biopsychosocial model, we address questions regarding BMI and its impact on dysmenorrhea among adolescent girls during menstruation. Specifically, we examine the longitudinal association between primary dysmenorrhea and BMI in adolescent girls in Uganda.

Methods

Using data from a National Institutes of Health-funded 3-arm Cluster Randomized Control Trial called Suubi4Her (N=1260; 14–17-year-old at recruitment), school-going adolescent girls from 47 public secondary schools in southwestern Uganda were randomly assigned to three study arms: control group receiving usual care comprising of sexual and reproductive health curriculum (n=16 schools, n= 408 students); and two active treatment arms: Economic Empowerment using incentivized youth development accounts (YDA) (n=16 schools, n=471 students), and YDA+ a family strengthening interventions that uses Multiple Family Group Meetings (MFG) to address adolescent girls and family health and wellbeing (n=15 schools, n=381 students). We used Generalized Estimating Equations (GEE), while controlling for the effect of the interventions to assess the association between BMI and dysmenorrhea, measured by a scale of 0 to 10 where participants were asked to indicate the average level of pain they experience during menstruation.

Results: At baseline, the average age was 15.4 years, and approximately 83% of the girls had both parents alive. The households had an average of 7 people, with typically 3 children. The results from the Generalized Estimating Equations (GEE) model indicated that obesity, defined as BMI of 29.7 kg/m² or higher at age 19, is associated with a reduced incidence of primary dysmenorrhea (b = -0.90, 95% CI: -1.54 to -0.26, p = 0.006), compared to those with a normal weight, which is defined as a BMI ranging from 18.7 to 25 kg/m² at age 19. Similarly, a one-year increase in age was associated with an increase in primary dysmenorrhea (b = 0.10, 95% CI: 0.005 to 0.19, p = 0.038). An increase in the possession of family assets was associated with a reduction in primary dysmenorrhea (b = -0.06, 95% CI: -0.09 to -0.02, p < 0.001). A good diet was also associated with a reduction in primary dysmenorrhea (b = -0.06, 95% CI: -0.09 to -0.02, p < 0.001). Furthermore, an increase in depression levels was associated with increased primary dysmenorrhea (b = 0.08, 95% CI: 0.06 to 0.10, p < 0.001).

Conclusion and Implications: This study details the relationship between age, socioeconomic factors, nutrition, mental health, and BMI in relation to dysmenorrhea. Our results advocate for integrated adolescent health strategies that emphasize economic empowerment, dietary improvements, and mental health support to alleviate dysmenorrhea. Notably, the unexpected association between higher BMI and reduced dysmenorrhea warrants further research to tailor interventions appropriate for the unique needs of Ugandan adolescents.